Medicare Advantage Plans

Medicare Advantage Plans are available from private companies that contract with the Centers for Medicare and Medicaid Services (CMS) to provide Medicare benefits to enrollees. These plans provide you coverage of Part A (hospital) and Part B (outpatient) instead of the federal government providing it. Medicare Advantage Plans are found under Part C of Medicare when you get Medicare through a private insurance company.

All Part C plans include some amount of cost-sharing (copays, coinsurance and deductibles). As a result, these plans are required to have a maximum out-of-pocket amount defined. If during the course of a year the beneficiary reaches that maximum, then the insurance covers 100 percent of health care costs for the remainder of the year.

Some general features of Medicare Advantage Plans include:

  • The plan must provide all benefits that are provided by Medicare; however, they can reimburse each benefit at a different level.
  • The plan may provide additional benefits than Medicare.
  • Residents must live in the plan's service area.
  • Members must have Medicare Part A and B.
  • Members must not have end-stage renal disease.
  • Members may pay the plan a monthly premium.
  • Members usually charge a copayment or coinsurance for services rendered.
  • Some plans offer prescription drug coverage.
  • Claims go directly to the Medicare Advantage company and bypass Medicare.
  • Medicare Advantage Plans are NOT supplements, and Medicare Supplements do not work with Medicare Advantage Plans.

Is Medicare Advantage right for me? Below are a few questions to ask yourself when contemplating a Medicare Advantage Plan:

  • Do my doctors and hospitals accept the plan's terms and conditions?
  • Do I need a referral to see a specialist?
  • What costs are involved in the plan?
  • Can I afford the annual out-of-pocket limit?
  • If I am not satisfied with my Medicare Advantage Plan, will my supplement take me back?